Could hormonal remission in prolactinomas be achieved with surgery? Our experience
DOI:
https://doi.org/10.25305/unj.145271Keywords:
pituitary adenoma, endoscopic surgery, prolactinomas, hormonal remissionAbstract
Objective. To determine the factors that lead to sustained hormonal remission in patients with pituitary adenomas.
Material and methods. In this study, retrospective analysis of 33 patients with pituitary adenomas with no prior DA treatment was performed. Ten (30.3 %) patients experienced microprolactinomas, 19 (57.6 %) — macroprolactinomas, 4 (12.1 %) — giant prolactinomas. All patients underwent endoscopic endonasal transsphenoidal surgery. Plasma PRL levels were obtained before surgery, and then 1 day, 1 week, 1 month, 3 months later and every 6th month after surgery. MRI monitoring was performed before surgery and then 3 and 12 months later, and then annually.
Results. Average preoperative plasma PRL serum levels for all patients with no preoperative DA treatment were 530 ng/mL (ranging 65–1440 ng/mL). Cavernous sinus invasion (Knosp 3, Knosp 4) was observed in 16 (48.4 %) cases. Depending on cavernous sinus invasion, hormonal remission with no DA therapy after surgery was achieved in Knosp 0–2 — in 16 (94.1 %) cases, Knosp 3 — in 4 (44.4 %) cases. In cases of Knosp 4 biochemical remission was not achieved in all 7 (100 %) patients. Only with further DA therapy biochemical remission was achieved. The biochemical remission was achieved in 10 (100 %) cases of microadenomas, in 7 (58.3 %) cases of macroadenomas after surgery with no DA therapy. Remission of endocrine symptoms was achieved in 18 (81.8 %) cases with no DA therapy after surgery. The follow-up was up to 3 years.
Conclusions. Biochemical remission could be surgically achieved in 100 % of cases with microprolactinomas. In cases of macroprolactinomas the adenoma size (up to 24 mm) has an important role in achieving biochemical remission. Cavernous sinus invasion (Knosp 0–2) is a prognostic factor. The ophthalmic disturbances regression in macro and giant pituitary adenomas was found to be achieved much faster in surgical management rather than using DA.
References
1. Mindermann T, Wilson CB. Age-related and gender-related occurrence of pituitary adenomas. Clin Endocrinol (Oxf). 1994 Sep;41(3):359-64. [CrossRef] [PubMed]
2. Ciccarelli A, Daly AF, Beckers A. The epidemiology of prolactinomas. Pituitary. 2005;8(1):3-6. [CrossRef] [PubMed]
3. Martin CH, Schwartz R, Jolesz F, Black PM. Transsphenoidal resection of pituitary adenomas in an intraoperative MRI unit. Pituitary. 1999 Aug;2(2):155-62. [PubMed]
4. Kalinin PL, Astaf’eva LI, Kadashev BA, Ismailov DB. [Indications for surgical treatment of prolactin-secreting pituitary adenomas]. Zh Vopr Neirokhir Im N N Burdenko. 2017;81(5):117-124. Russian. [CrossRef] [PubMed]
5. Colao A, Sarno AD, Cappabianca P, Briganti F, Pivonello R, Somma CD, Faggiano A, Biondi B, Lombardi G. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. Eur J Endocrinol. 2003 Mar;148(3):325-31. [CrossRef] [PubMed]
6. Corsello SM, Ubertini G, Altomare M, Lovicu RM, Migneco MG, Rota CA, Colosimo C. Giant prolactinomas in men: efficacy of cabergoline treatment. Clin Endocrinol (Oxf). 2003 May;58(5):662-70. [CrossRef] [PubMed]
7. Koutourousiou M, Vaz Guimaraes Filho F, Fernandez-Miranda JC, Wang EW, Stefko ST, Snyderman CH, Gardner PA. Endoscopic Endonasal Surgery for Tumors of the Cavernous Sinus: A Series of 234 Patients. World Neurosurg. 2017 Jul;103:713-732. [CrossRef] [PubMed]
8. Shrivastava RK, Arginteanu MS, King WA, Post KD. Giant prolactinomas: clinical management and long-term follow up. J Neurosurg. 2002 Aug;97(2):299-306. [CrossRef] [PubMed]
9. Thorner MO, McNeilly AS, Hagan C, Besser GM. Long-term treatment of galactorrhoea and hypogonadism with bromocriptine. Br Med J. 1974 May 25;2(5916):419-22. [CrossRef] [PubMed] [PubMed Central]
10. Akin S, Isikay I, Soylemezoglu F, Yucel T, Gurlek A, Berker M. Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases. Acta Neurochir (Wien). 2016 May;158(5):933-42. [CrossRef] [PubMed]
11. Wang S, Lin S, Wei L, Zhao L, Huang Y. Analysis of operative efficacy for giant pituitary adenoma. BMC Surg. 2014 Aug 28;14:59. [CrossRef] [PubMed] [PubMed Central]
12. Rutkowski MJ, Aghi MK. Medical versus surgical treatment of prolactinomas: an analysis of treatment outcomes. Expert Rev Endocrinol Metab. 2018 Jan;13(1):25-33. [CrossRef] [PubMed]
13. Ioachimescu AG, Fleseriu M, Hoffman AR, Vaughan Iii TB, Katznelson L. Psychological effects of Dopamine Agonist Treatment in Patients with Hyperprolactinemia and Prolactin Secreting Adenomas. Eur J Endocrinol. 2018 Oct 1. pii: EJE-18-0682.R1. [CrossRef] [PubMed]
14. Cappabianca P, Cavallo LM, Colao A, Del Basso De Caro M, Esposito F, Cirillo S, Lombardi G, de Divitiis E. Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg. 2002 Dec;45(4):193-200. [CrossRef] [PubMed]
15. Molitch ME. Diagnosis and Treatment of Pituitary Adenomas: A Review. JAMA. 2017 Feb 7;317(5):516-524. [CrossRef] [PubMed]
16. Molitch ME. Medical treatment of prolactinomas. Endocrinol Metab Clin North Am. 1999 Mar;28(1):143-69, vii. [CrossRef] [PubMed]
17. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA; Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Feb;96(2):273-88. [CrossRef] [PubMed]
18. Choe JH, Lee KS, Jeun SS, Cho JH, Hong YK. Endocrine outcome of endoscopic endonasal transsphenoidal surgery in functioning pituitary adenomas. J Korean Neurosurg Soc. 2008 Sep;44(3):151-5. [CrossRef] [PubMed] [PubMed Central]
19. Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg. 1997 Jul;87(1):44-51. [CrossRef] [PubMed]
20. Gondim JA, Schops M, de Almeida JP, de Albuquerque LA, Gomes E, Ferraz T, Barroso FA. Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center. Pituitary. 2010;13(1):68-77. [CrossRef] [PubMed]
21. Tang H, Wei YX, Yang WL, Shang HB, Zhao WG, Wu ZB. [Improvement and effect analysis of a new neuroendoscopic trans-nasal-sphenoidal pituitary tumor resection approach]. Zhonghua Yi Xue Za Zhi. 2018 Oct 9; 98(37):3021-3024. Chinese. [CrossRef] [PubMed]
22. Noronha S, Stokes V, Karavitaki N, Grossman A. Treating prolactinomas with dopamine agonists: always worth the gamble? Endocrine. 2016 Feb;51(2):205-10. [CrossRef] [PubMed]
23. Han YL, Chen DM, Zhang C, Pan M, Yang XP, Wu YG. Retrospective analysis of 52 patients with prolactinomas following endoscopic endonasal transsphenoidal surgery. Medicine (Baltimore). 2018 Nov;97(45):e13198. [CrossRef] [PubMed]
24. Ceylan S, Koc K, Anik I. Endoscopic endonasal transsphenoidal approach for pituitary adenomas invading the cavernous sinus. J Neurosurg. 2010 Jan;112(1):99-107. [CrossRef] [PubMed]
25. Lv L, Hu Y, Yin S, Zhou P, Yang Y, Ma W, Zhang S, Wang X, Jiang S. Giant Prolactinomas: Outcomes of Multimodal Treatments for 42 Cases with Long-Term Follow-Up. Exp Clin Endocrinol Diabetes. 2018 Jun 25. [CrossRef] [PubMed]
26. Ali S, Miller KK, Freudenreich O. Management of psychosis associated with a prolactinoma: case report and review of the literature. Psychosomatics. 2010 Sep-Oct;51(5):370-6. [CrossRef] [PubMed] [PubMed Central]
27. Dallapiazza RF, Jane JA Jr. Outcomes of endoscopic transsphenoidal pituitary surgery. Endocrinol Metab Clin North Am. 2015 Mar;44(1):105-15. [CrossRef] [PubMed]
28. Campbell PG, Kenning E, Andrews DW, Yadla S, Rosen M, Evans JJ. Outcomes after a purely endoscopic transsphenoidal resection of growth hormone-secreting pituitary adenomas. Neurosurg Focus. 2010 Oct;29(4):E5. [CrossRef] [PubMed]
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Copyright (c) 2018 Orest I. Palamar, Andriy P. Huk, Ruslan V. Aksyonov, Dmytro I. Okonskyi, Dmytro S. Teslenko
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